Sunday, September 06, 2009

Since we are moving toward socialism with ObamaCare, the time has come to do the same with other professions—especially lawyers. Physician committees can decide whether lawyers are necessary in any given situation.

At a town-hall meeting in Portsmouth, N.H., last month, our uninformed lawyer in chief suggested that we physicians would rather chop off a foot than manage diabetes since we would make more money doing surgery. Then President Obama compounded his attack by claiming a doctor's reimbursement is between "$30,000" and "$50,000" for such amputations! (Actually, such surgery costs only about $1,500.)

Physicians have never been so insulted. Because of these affronts, I will gladly volunteer for the important duty of controlling and regulating lawyers. Since most of what lawyers do is repetitive boilerplate or pushing paper, physicians would have no problem dictating what is appropriate for attorneys. We physicians know much more about legal practice than lawyers do about medicine.Following are highlights of a proposed bill authorizing the dismantling of the current framework of law practice and instituting socialized legal care:• Contingency fees will be discouraged, and eventually outlawed, over a five-year period. This will put legal rewards back into the pockets of the deserving—the public and the aggrieved parties. Slick lawyers taking their "cut" smacks of a bookie operation. Attorneys will be permitted to keep up to 3% in contingency cases, the remainder going into a pool for poor people.

• Legal "DRGs." Each potential legal situation will be assigned a relative value, and charges limited to this amount. Program participation and acceptance of this amount is mandatory, regardless of the number of hours spent on the matter. Government schedules of flat fees for each service, analogous to medicine's Diagnosis Related Groups (DRGs), will be issued. For example, any divorce will have a set fee of, say, $1,000, regardless of its simplicity or complexity. This will eliminate shady hourly billing. Niggling fees such as $2 per page photocopied or faxed would disappear. Who else nickels-and-dimes you while at the same time charging hundreds of dollars per hour? I'm surprised lawyers don't tack shipping and handling onto their bills. • Legal "death panels." Over 75? You will not be entitled to legal care for any matter. Why waste money on those who are only going to die soon? We can decrease utilization, save money and unclog the courts simultaneously. Grandma, you're on your own.• Ration legal care. One may need to wait months to consult an attorney. Despite a perceived legal need, physician review panels or government bureaucrats may deem advice unnecessary. Possibly one may not get representation before court dates or deadlines. But that' s tough: What do you want for "free"?

• Physician controlled legal review. This is potentially the most exciting reform, with doctors leading committees for determining the necessity of all legal procedures and the fairness of attorney fees. What a wonderful way for doctors to get even with the sharks attempting to eviscerate the practice of medicine.

• Discourage/eliminate specialization. Legal specialists with extra training and experience charge more money, contributing to increased costs of legal care, making it unaffordable for many. This reform will guarantee a selection of mediocre, unmotivated attorneys but should help slow rising legal costs. Big shot under indictment? Classified National Archives documents down your pants? Sitting president defending against impeachment? Have FBI agents found $90,000 in your freezer? Too bad. Under reform you too may have to go to the government legal shop for advice.

• Electronic legal records. We should enter the digital age and computerize and centralize legal records nationwide. All files must be in a standard, preferably inconvenient, format and must be available to government agencies. A single database of judgments, court records, client files, etc. will decrease legal expenses. Anyone with Internet access will be able to search the database, eliminating unjustifiable fees charged by law firms for supposedly proprietary information, while fostering transparency. It will enable consumers to dump their clunker attorneys and transfer records easily.

• Ban legal advertisements. Catchy phone numbers such as 1-800-LAWYERS would be seized by the government and repurposed for reporting unscrupulous attorneys.• New government oversight. Government overhead to manage the legal system will include a cabinet secretary, commissioners, ombudsmen, auditors, assistants, czars and departments.

• Collect data about the supply of and demand for attorneys.Create a commission to study the diversity and geographic distribution of attorneys, with power to stipulate and enforce corrective actions to right imbalances. The more bureaucracy the better. One can never have too many eyes watching these sleazy sneaks.

• Lawyer Reduction Act (H.R. -3200). A self-explanatory bill that not only decreases the number of law students, but also arbitrarily removes 3,200 attorneys from practice each year. Textbook addition by subtraction.

Enthusiastically embracing the above legal changes can serve as a "teachable moment" and will go a long way toward giving the lawyers who run Congress a taste of their own medicine.

25 comments:

"Discourage/eliminate specialization. Legal specialists with extra training and experience charge more money, contributing to increased costs of legal care, making it unaffordable for many. " Are they really advocating discouragement of specialties for doctors? How does that make sense to anyone on any level?

It's a little tongue in cheek, but yes, there is a push for greater pay parity for generalists compared to specialists due to the perceived need for primary care docs in this country. If you reduce the incentives for specialization fewer people will take the extra effort to undergo extended training to become trained in specialties.

And as Dr. Rafal's article refers, here's Obama saying that primary care docs don't do a good job taking care of diabetics because they are not well reimbursed for it whereas a surgeon will get "$30-$50 thousand" for an amputation! Not only is that a slam on primary care, the multi-thousand dollar claim is a huge canard when Medicare only reimburses the surgeon to the tune of ~$1000, which includes 90 days of follow up care.

JA, you're not one of those types who still thinks Obama is the greatest thing since sliced cheese, are you?

I loved this piece. Unfortunately as long as the lawyers continue to control the government and make up most of its elected representatives, we're not likely to see socialized lawyers. It's a classic "Do as we say, not as we do"

I enjoyed the article, I thought it was very funny. I hope people start realizing the best people qualified for making the medical decisions are doctors. Maybe Obama should appoint doctors to figure out the best way to reform health care.

Just like when you turn on the TV to those religious issues programs and the only Jews they can find to debate the subject are either near ignorant of Judaism or self-hating Jews, when governments hire doctors to fix problem, they select physicians who either are very poor clinicians with little real world experience or self-hating doctors. How else to get the answers they want to hear and defend them by saying "Well we asked doctors!"?

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English translation: as long as any doctor, anywhere, anytime, is held accountable for their medical malpractice, we have a perfect excuse not to do anything, ever, ever, ever about our other problems.

Of course the Achilles foot in your argument is that the government is not subsidizing "legal care". That is, all the things that you are talking about, such as rationing care, DRG's, limiting patient's access to specialized health care, etc., are all paid for by government programs.

Note that no one will stop a patient to get whatever care he or she wants as long as the patient is paying cash for it. You want to see a neurologist because you have a mild headache? Sure, pay cash and see 5 of them! But if the government is paying the tab, well it wants to make sure that the visit is appropriate.

Similarly, no one does (nor should) stop any one from obtaining a lawyer as long as the person wants to pay for it. If, for whatever reason, some day, the government wants to provide LEGALCARE which dishes legal insurance, then the government has every right, and should, set boundaries for what it does or does not cover.

By the way, it DOES cost a lot of money for amputations. True, the doctor's fee for an amputation is about $1,000, but also consider the hospital fee, the anesthesia fee, the rehabilitation costs, and prosthetic costs that are associated with an amputation, and the costs easily go up to $50,000.

Why is that insulting?

I think Obama was making the point that it would have been easier and cheaper to treat a diabetic so that she does not come to losing her foot to an amputation.

"Of course the Achilles foot in your argument is that the government is not subsidizing "legal care"."

How is that an achilles' anything? The whole point is that just as its inappropriate for the government to get involved in socializing plumbing or lawyering, it's inappropriate for it to get involved in doctoring.

"I think Obama was making the point that it would have been easier and cheaper to treat a diabetic so that she does not come to losing her foot to an amputation."

His stated point was that due to the poor reimbursement plans, there is poor incentive to treat diabetes as a chronic disease but big incentive to perform an amputation. He made it seem like doctors would rather cut off someone's leg for a profit of $50,000 than correctly treat their diabetes.

"just as its inappropriate for the government to get involved in socializing plumbing or lawyering, it's inappropriate for it to get involved in doctoring."

If you really believe in what you are saying, then you are advocating that the government stop offering Medicare to the elderly, stop offering Medicaid to the poor, and Stop offering care to the veterans.

If you want the government to stop all of the above, then I would agree that the government would have no basis to meddle in a doctor's affair just as it does not for lawyers and plumbers.

"Right now . . . if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's 30,000, 40, 50,000 dollars immediately the surgeon is reimbursed.

"Well, why not make sure that we're also reimbursing the care that prevents the amputation. Right? That will save us money,"

This is of course a misquote and it is clear the surgeon does not get paid that. What he meant, I think, was that the cost of an amputation to Medicare or other insurance company is 30-50K.

"If you really believe in what you are saying, then you are advocating that the government stop offering Medicare to the elderly, stop offering Medicaid to the poor, and Stop offering care to the veterans."

I didn't say they should stop offering care, but they should never have started offering "coverage."

"This is of course a misquote and it is clear the surgeon does not get paid that. What he meant, I think, was that the cost of an amputation to Medicare or other insurance company is 30-50K."

That's not a misquote, that's exactly what he said. He said that, probably believing that a surgeon gets paid $50K for an amputation. He said something similar a few weeks earlier about doctors making a bundle by removing childrens' tonsils instead of treating their allergies.

As an argument to support his plan to change medicare/caid reimbursements to better favor primary care, he's saying that the current reimbursement plans alter doctors' treatments towards what's profitable rather than what is best for the patient. That's an offensive statement.

Th current reimbursement system does indeed favors high impact surgical treatment over preventative remedies. A diabetic who goes to a nutritionist will generally have either no reimbursement to her nutritionist, or at best will get about $30 for a session. However, the same diabetic, who has some eye problems will have laser treatment in her eyes with the surgeon getting about a $1,000 for it. It is obviously more profitable to treat diabetic retinopathy than to have preventative glucose control. This is a fact. Why are you offended?

I'm offended because in the way he said it, he implied that doctors are treating patients incorrectly for profit. And to make it clear how unscrupulous he thinks doctors are he stated that a surgeon makes tens of thousands of dollars of undeserved money for this second rate care.

This all makes doctors out to not just be unprofessional, but malicious crooks.

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